Alcohol consumption among adults in Germany: heavy episodic drinking

Consuming harmful amounts of alcohol is considered a contributing factor in over 200 diseases. Heavy episodic drinking is a particularly risky drinking pattern, with possible consequences such as acute alcohol intoxication, injuries and violence. GEDA 2014/2015-EHIS defines heavy episodic drinking as the consumption of six or more alcoholic beverages on one occasion at least once per month. 24.9% of women and 42.6% of men show this drinking pattern at least once per month. Regular heavy episodic drinking is most common among 18- to 29-year-olds. The prevalence of heavy episodic drinking among highly educated women (all age groups) and men (aged over 45) is lower than it is among those with lower levels of education. The prevention of harmful levels of alcohol consumption requires measures including social and environmental interventions as well as targeting the individual behaviour which are focused on young adults as well as the diverse drinking patterns seen among groups with different levels of education.


Introduction
Alcohol is a potentially addictive psychoactive substance.Consuming harmful levels of alcohol is considered a contributing factor to over 200 diseases; globally, it is among the five key risk factors for disease, impairment and death [1].In addition, to the impacts harmful amounts of alcohol can potentially have on a person's health, the World Health Organization (WHO) also highlights the socioeconomic costs for individuals who drink and the consequences for others and society in general [1].For society, the consequences of people consuming harmful levels of alcohol include the direct costs to the health system, as well as the costs related to the loss of productivity and immaterial costs such as the loss of quality of life.In Germany, alcohol consumption is estimated to cost the economy around EUR 40 billion annually, with around one quarter of this sum being spent directly on the health care system [2,3].
Heavy episodic drinking is a drinking pattern which poses a particularly high risk to an individual's health and can lead to acute alcohol intoxication, injuries and violence.On the long-term, it can lead to addiction and damages to multiple organs [4].Such damage can occur even if a person's alcohol consumption is, on average, relatively low [1].To reduce the population's consumption of harmful levels of alcohol, the WHO has developed global and European strategies [5,6].The WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases strives for a relative 10% reduction of harmful drinking patterns by 2025 (with 2010 levels as a benchmark) [7].In part, the WHO strategy guides Germany's national health target 'Reduce alcohol consumption', which was initially published in 2015 [8].

Indicator
Heavy episodic drinking (HED) is defined as the intake of 60 g or more of pure alcohol at a single occasion at least once per month [1].This is the equivalent to six standard drinks containing roughly 10 g of pure alcohol per glass.To assess the frequency and amounts of alcohol people consume, the German Health Update 2014/2015-EHIS (GEDA 2014/2015-EHIS) survey used the instruments provided by the European Health Interview Survey (EHIS) [9].To assess HED, the survey asked: 'In the past 12 months, how often have you had 6 or more drinks containing alcohol on one occasion?For instance, during a party, a meal, an evening out with friends, alone at home, …'.To calculate the indicator, the nine possible answers were condensed into four categories: (1) at least once a week (every day or almost every day, 5-6 days a week, 3-4 days a week, 1-2 days a week); (2) every month (on 2-3 days per month, once a month); (3) less than once a month; and (4) never (not in the past 12 months, never in my whole life).Furthermore, the category of at least monthly heavy episodic drinking was established that combines the categories at least once a week and every month.The results are stratified based on gender, age and education, and for at least monthly heavy episodic drinking, according to gender and German federal state.Statistically, where confidence intervals do not overlap, the survey assumes significant differences between groups.
The analyses are based on the data received from 23,704 respondents aged 18 and above (12,953 women, 10,751 men) who gave valid answers on heavy episodic drinking.Calculations were carried out using a weighting factor that corrects for deviations within the sample from the German population (as of 31 December 2014) with regard to gender, age, district type and education.The district type accounts for the degree of urbanisation and reflects the regional distribution in Germany.The International Standard Classification of Education (ISCED) was used to ensure that the responses provided on educational levels were comparable [10].A detailed description of the methodology applied in the GEDA 2014/2015-EHIS study can be found in the article German Health Update: New data for Germany and Europe in issue 1/2017 of the Journal of Health Monitoring.

Results and discussion
48.8% of women and 29.7% of men responded that they had never, or at least not during the past 12 months, drunk six or more alcoholic beverages on a single occasion.24.9% of women and 42.6% of men (Table 1  Data protection: This study was undertaken in strict accordance with the data protection regulations set out in the German Federal Data Protection Act and was approved by the German Federal Commissioner for Data Protection and Freedom of Information.Participation in the study was voluntary.The participants were fully informed about the study's aims and content, and about data protection.All participants provided written informed consent. More information in German is available at www.geda-studie.dedifferences in the prevalence of heavy episodic drinking among women exist.In the older age groups (≥ 30 years), around one fifth of women drink six alcoholic beverages or more on a single occasion at least once per month.For men, the prevalence of heavy episodic drinking drops with age; yet still over one third of men (35.1%) aged 65 and over engage in heavy episodic drinking at least once per month.
Across all age groups, there are fewer highly educated women who drink six or more alcoholic beverages in a single session than women with a lower or medium level of education.For men in the 18-44 age group, no such association with education appears to exist.For men over 45, the prevalence of heavy episodic drinking among those highly educated is lower than among the group with a lower level of education.Compared to figures for the consumption of risky amounts, the figures for heavy episodic drinking reveal an inverse education gradient.These results are in line with other surveys that indicate the higher prevalence of risky drinking patterns, such as heavy episodic drinking, in socially disadvantaged groups [11].Moreover, drinking and Table2) said they engaged in heavy episodic drinking at least once per month.Monthly heavy episodic drinking is most widespread among 18-to 29-year-olds (women 35.6%, men 54.3%).In the other age groups, no notable